Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection
Abstract Background Despite growing interest in universal screening for congenital CMV infection (cCMV), and data to support treatment for cases with central nervous system (CNS) involvement, there is limited regarding the optimal imaging modalities to identify CNS involvement. The objective of this...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | BMC Pediatrics |
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| Online Access: | http://link.springer.com/article/10.1186/s12887-019-1562-z |
| _version_ | 1818277795430662144 |
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| author | Mina Smiljkovic Christian Renaud Bruce Tapiero Valérie Lamarre Fatima Kakkar |
| author_facet | Mina Smiljkovic Christian Renaud Bruce Tapiero Valérie Lamarre Fatima Kakkar |
| author_sort | Mina Smiljkovic |
| collection | DOAJ |
| description | Abstract Background Despite growing interest in universal screening for congenital CMV infection (cCMV), and data to support treatment for cases with central nervous system (CNS) involvement, there is limited regarding the optimal imaging modalities to identify CNS involvement. The objective of this study was to assess the concordance between head ultrasound (US) and magnetic resonance imaging (MRI) or computed tomography (CT), in identifying neurological abnormalities in infants with cCMV infection, and to determine whether the addition of advanced neuroimaging after US had an impact on clinical management. Methods Retrospective review of infants with cCMV infection, referred to the Centre d’Infectiologie Mère-Enfant (CIME) at Sainte-Justine Hospital Center in Montreal, between 2008 and 2016. Only patients who underwent head US followed by and brain MRI or CT scan were included in this analysis. Results Of 46 cases of cCMV identified during the study period, 34 (74%) had a head US followed by MRI (n = 28, 61%), or CT scan (n = 6, 13%). In the majority of cases (n = 24, 71%), both images were concordant (11 both reported abnormal, 13 both reported normal). In 5 cases, US was reported normal and subsequent imaging (MRI = 4, CT = 1); reported abnormal. In all 5 cases patients were clinically symptomatic and met treatment criteria even in the absence of neuroimaging findings. In 5 cases, US was reported abnormal with a subsequent normal MRI (4) or CT (1); in 2 of these cases, patients were clinically symptomatic and met treatment criteria regardless of neuroimaging findings. However, in 3 cases, the patients were clinically asymptomatic, and in 2 of these cases, treated based only on the abnormal US findings. Conclusions In this study, we found that that sequential US and MRI were concordant in the majority (71%) of cases in detecting abnormalities potentially associated with cCMV infection. While the addition of MRI to baseline head ultrasound did not influence the decision to treat in clinically symptomatic infants, the addition of MRI to infants with abnormal HUS imaging who are clinically asymptomatic could help refine treatment decisions in these cases. |
| first_indexed | 2024-12-12T23:07:13Z |
| format | Article |
| id | doaj.art-092d81e31eb64fdcb96754511104bc7f |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-12T23:07:13Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-092d81e31eb64fdcb96754511104bc7f2022-12-22T00:08:40ZengBMCBMC Pediatrics1471-24312019-06-011911610.1186/s12887-019-1562-zHead ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infectionMina Smiljkovic0Christian Renaud1Bruce Tapiero2Valérie Lamarre3Fatima Kakkar4Department of Pediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of TorontoDepartment of Microbiology and Infectious Diseases, CHU Sainte-Justine, Université de MontréalDepartment of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de MontréalDepartment of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de MontréalDepartment of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de MontréalAbstract Background Despite growing interest in universal screening for congenital CMV infection (cCMV), and data to support treatment for cases with central nervous system (CNS) involvement, there is limited regarding the optimal imaging modalities to identify CNS involvement. The objective of this study was to assess the concordance between head ultrasound (US) and magnetic resonance imaging (MRI) or computed tomography (CT), in identifying neurological abnormalities in infants with cCMV infection, and to determine whether the addition of advanced neuroimaging after US had an impact on clinical management. Methods Retrospective review of infants with cCMV infection, referred to the Centre d’Infectiologie Mère-Enfant (CIME) at Sainte-Justine Hospital Center in Montreal, between 2008 and 2016. Only patients who underwent head US followed by and brain MRI or CT scan were included in this analysis. Results Of 46 cases of cCMV identified during the study period, 34 (74%) had a head US followed by MRI (n = 28, 61%), or CT scan (n = 6, 13%). In the majority of cases (n = 24, 71%), both images were concordant (11 both reported abnormal, 13 both reported normal). In 5 cases, US was reported normal and subsequent imaging (MRI = 4, CT = 1); reported abnormal. In all 5 cases patients were clinically symptomatic and met treatment criteria even in the absence of neuroimaging findings. In 5 cases, US was reported abnormal with a subsequent normal MRI (4) or CT (1); in 2 of these cases, patients were clinically symptomatic and met treatment criteria regardless of neuroimaging findings. However, in 3 cases, the patients were clinically asymptomatic, and in 2 of these cases, treated based only on the abnormal US findings. Conclusions In this study, we found that that sequential US and MRI were concordant in the majority (71%) of cases in detecting abnormalities potentially associated with cCMV infection. While the addition of MRI to baseline head ultrasound did not influence the decision to treat in clinically symptomatic infants, the addition of MRI to infants with abnormal HUS imaging who are clinically asymptomatic could help refine treatment decisions in these cases.http://link.springer.com/article/10.1186/s12887-019-1562-zCytomegalovirusInfectionCongenitalPediatricsImaging |
| spellingShingle | Mina Smiljkovic Christian Renaud Bruce Tapiero Valérie Lamarre Fatima Kakkar Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection BMC Pediatrics Cytomegalovirus Infection Congenital Pediatrics Imaging |
| title | Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| title_full | Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| title_fullStr | Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| title_full_unstemmed | Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| title_short | Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| title_sort | head ultrasound ct or mri the choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection |
| topic | Cytomegalovirus Infection Congenital Pediatrics Imaging |
| url | http://link.springer.com/article/10.1186/s12887-019-1562-z |
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